Does D31.32 require prior authorization?

No, D31.32 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D31.32` — Benign neoplasm of left choroid

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
SCODI (CPT 92133) is covered when performed to evaluate or monitor optic nerve damage/optic neuropathy.
SCODI (CPT 92134) is covered for management of retinal diseases including wet age-related macular degeneration/choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
SCODI may be covered monthly (one scan per eye) for patients undergoing active intravitreal drug treatment for retinal disease.
SCODI may be covered monthly for other retinal/macular conditions undergoing rapid clinical change requiring aggressive therapy or frequent follow-up (examples: macular hole, traction retinal detachment).
Fundus photography is covered when medical necessity is documented in the medical record, including relevant history, exam, diagnostic test results, and retention of the photographs and an interpretation/report.

A57483 — Billing and Coding: Visual Fields

J05

A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L34615 — Visual Fields

J05

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

A56537

Ask Verity about documentation requirements, denial risks, or coverage in your state.